Healthcare Provider Details

I. General information

NPI: 1477710457
Provider Name (Legal Business Name): THOMAS HORTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 OLD GEORGETOWN RD SUITE 303
BETHESDA MD
20814-1911
US

IV. Provider business mailing address

10401 OLD GEORGETOWN RD SUITE 303
BETHESDA MD
20814-1911
US

V. Phone/Fax

Practice location:
  • Phone: 301-564-4464
  • Fax: 301-530-4700
Mailing address:
  • Phone: 301-564-4464
  • Fax: 301-530-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8348
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: